One in four Americans facing end-of-life has served in the Armed Services of the United States and may have been responsible for traumatic events. Such experiences may harbor unresolved spiritual and/or psychological issues that may interfere with a peaceful end-of-life.

Realizing these veterans may benefit from acknowledgement of their military experiences—and that failure to recognize the potential effects of military trauma may result in unresolved issues—several Ohio institutions have instituted a bedside recognition program to honor veterans, noted Elizabeth Delaney, CNS, FNP-BC, OCN, ACHPN, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, and colleagues. The bedside recognition ceremony, developed following a review of the Ohio Hospice Veteran Partnership recommendations, provides an opportunity for veterans to deal with unresolved issues regarding spirituality and posttraumatic stress disorder (PTSD).

Veterans have complex health care needs when facing a terminal illness or end-of-life, including spiritual distress and/or resurgence of PTSD, they pointed out at the Oncology Nursing Society 36th Annual Congress. These problems may be evident in combat soldiers and prisoners of war (POWs) who have previously faced the grim realities of death. Veterans may have witnessed or caused traumatic deaths that may alter how they come to terms with their own death. Unresolved grief and/or survivor guilt may prevent their journey to a peaceful death.

The purpose of the project was to raise awareness of specific palliative care needs of veterans and measure effects of programs and end-of-life issues. Following admission to the palliative care team, veterans were offered to participate in a bedside recognition ceremony of service to the United States. Staff, family, and a veteran volunteer gathered and acknowledged the veteran's service; the veteran volunteer then presented the veteran with a pin. This interaction provided an opportunity for the veteran to discuss memories, and unresolved spiritual and psychological issues often surfaced.

Information provided by the veterans often prompted referrals to appropriate resources to address concerns. During the interactions, verbal and visual cues were observed indicating positive feedback from the veteran, family, and staff, and photos of the ceremonies provided evidence of tearful responses, indicating a deeply emotional response to this recognition. The program received overwhelming positive evaluations. The investigators concluded by noting that freedom is owed to these American soldiers; therefore, all health care providers must work together to provide the best possible care by becoming aware of the oft silent challenges and needs of veterans, especially at end-of-life.